Continuous beta-lactam infusion in critically ill patients: the clinical evidence

Abdul-Aziz, Mohd H., Dulhunty, Joel M., Bellomo, Rinaldo, Lipman, Jeffrey and Roberts, Jason A. (2012) Continuous beta-lactam infusion in critically ill patients: the clinical evidence. Annals of Intensive Care, 2 1: . doi:10.1186/2110-5820-2-37

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Author Abdul-Aziz, Mohd H.
Dulhunty, Joel M.
Bellomo, Rinaldo
Lipman, Jeffrey
Roberts, Jason A.
Title Continuous beta-lactam infusion in critically ill patients: the clinical evidence
Journal name Annals of Intensive Care   Check publisher's open access policy
ISSN 2110-5820
Publication date 2012-08-16
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1186/2110-5820-2-37
Open Access Status DOI
Volume 2
Issue 1
Total pages 16
Place of publication Heidelberg, Germany
Publisher SpringerOpen
Collection year 2013
Language eng
Abstract There is controversy over whether traditional intermittent bolus dosing or continuous infusion of beta-lactam antibiotics is preferable in critically ill patients. No significant difference between these two dosing strategies in terms of patient outcomes has been shown yet. This is despite compelling in vitro and in vivo pharmacokinetic/pharmacodynamic (PK/PD) data. A lack of significance in clinical outcome studies may be due to several methodological flaws potentially masking the benefits of continuous infusion observed in preclinical studies. In this review, we explore the methodological shortcomings of the published clinical studies and describe the criteria that should be considered for performing a definitive clinical trial. We found that most trials utilized inconsistent antibiotic doses and recruited only small numbers of heterogeneous patient groups. The results of these trials suggest that continuous infusion of beta-lactam antibiotics may have variable efficacy in different patient groups. Patients who may benefit from continuous infusion are critically ill patients with a high level of illness severity. Thus, future trials should test the potential clinical advantages of continuous infusion in this patient population. To further ascertain whether benefits of continuous infusion in critically ill patients do exist, a large-scale, prospective, multinational trial with a robust design is required.
Keyword Beta-lactam antibiotic
Continuous infusion
Critically ill
Pharmacodynamic
Pharmacokinetic
Treatment outcome
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2013 Collection
School of Medicine Publications
 
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Created: Fri, 14 Dec 2012, 17:28:20 EST by Sia Athanasas on behalf of Anaesthesiology and Critical Care - RBWH